Trial reportClinical journal of the American Society of Nephrology : CJASN2017
Two phosphAte taRGets in End-stage renal disease Trial (TARGET): A Randomized Controlled Trial.
Trial report in Clinical journal of the American Society of Nephrology : CJASN, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 38 citations in OpenAlex.
- Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD).The Cochrane database of systematic reviews · 2025Pooled it
- A meta-analysis of phosphate binders lanthanum carbonate versus sevelamer hydrochloride in patients with end-stage renal disease undergoing hemodialysis.African health sciences · 2018Pooled it
- A randomized controlled trial of different serum phosphate ranges in subjects on hemodialysis.BMC nephrology · 2019Trial
- The effects of elevated phosphate on the kidney - damaging the gatekeeper.Pflugers Archiv : European journal of physiology · 2026Review
- "Hi"s and "Lo"s of Targeting Serum Phosphate Levels in Hemodialysis.Journal of the American Society of Nephrology : JASN · 2025Article
- Higher versus Lower Phosphate Targets for Patients Undergoing In-Center Hemodialysis: A Randomized Controlled Trial.Journal of the American Society of Nephrology : JASN · 2025Article
- Anticoagulation for Patients with Atrial Fibrillation Receiving Dialysis: A Pilot Randomized Controlled Trial.Journal of the American Society of Nephrology : JASN · 2025Article
- The Pathologic Actions of Phosphate in CKD.Kidney360 · 2025Review
- Chronic Kidney Disease-Mineral and Bone Disorder Management in 4D: The Case for Dynamic Treatment Regime Methods to Optimize Care.Current osteoporosis reports · 2025Review
- Unmet needs in clinical trials in CKD: questions we have not answered and answers we have not questioned.Clinical kidney journal · 2023Review
- Article
- Design and Rationale of HiLo: A Pragmatic, Randomized Trial of Phosphate Management for Patients Receiving Maintenance Hemodialysis.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2021Article
- Multidisciplinary Perspectives of Current Approaches and Clinical Gaps in the Management of Hyperphosphatemia.International journal of nephrology and renovascular disease · 2021Review
- State-of-the-Art Management of Hyperphosphatemia in Patients With CKD: An NKF-KDOQI Controversies Perspective.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2021Article
- Impact of longer term phosphorus control on cardiovascular mortality in hemodialysis patients using an area under the curve approach: results from the DOPPS.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2020Article
- Phosphate binders in chronic kidney disease: an updated narrative review of recent data.Journal of nephrology · 2020Review
- Controversies in the Management of Secondary Hyperparathyroidism in Chronic Kidney Disease.Current osteoporosis reports · 2019Review
- Targeting Gastrointestinal Transport Proteins to Control Hyperphosphatemia in Chronic Kidney Disease.Drugs · 2018Review
- Evidence basis for integrated management of mineral metabolism in patients with end-stage renal disease.Current opinion in nephrology and hypertension · 2018Review
- Review
Corrections and comments
- Commented on by
Authors and funding
15 authors at 8 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesHyperphosphatemia is common among recipients of maintenance dialysis and is associated with a higher risk of mortality and cardiovascular events. A large randomized trial is needed to determine whether lowering phosphate concentrations with binders improves patient-important outcomes. To inform such an effort we conducted a pilot randomized controlled trial. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a randomized controlled trial of prevalent hemodialysis recipients already receiving calcium carbonate as a phosphate binder at five Canadian centers between March 31, 2014 and October 2, 2014. Participants were randomly allocated to 26 weeks of an intensive phosphate goal of 2.33-4.66 mg/dl (0.75-1.50 mmol/L) or a liberalized target of 6.20-7.75 mg/dl (2.00-2.50 mmol/L) by titrating calcium carbonate using a dosing nomogram. The primary outcome was the difference in the change in serum phosphate from randomization to 26 weeks.
resultsFifty-three participants were randomized to the intensive group and 51 to the liberalized group. The median (interquartile range) daily dose of elemental calcium at 26 weeks was 1800 (1275-3000) mg in the intensive group, and 0 (0-500) mg in the liberalized group. The mean (SD) serum phosphate at 26 weeks was 4.53 (1.12) mg/dl (1.46 [0.36] mmol/L) in the intensive group and 6.05 (1.40) mg/dl (1.95 [0.45] mmol/L) in the liberalized group. Phosphate concentration in the intensive group declined by 1.24 (95% confidence interval, 0.75 to 1.74) mg/dl (0.40 [95% confidence interval, 0.24 to 0.56] mmol/L) compared with the liberalized group. There were no statistically significant differences between the two groups in the risk of hypercalcemia, hypocalcemia, parathyroidectomy, or major vascular events.
conclusionsIt is feasible to achieve and maintain a difference in serum phosphate concentrations in hemodialysis recipients by titrating calcium carbonate. A large trial is needed to determine if targeting a lower serum phosphate concentration improves patient-important outcomes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.